[The functioning of the fibrinolytic system in Behçet's syndrome].
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Biomedical subjects
Publications and source records attributed to F Asbeck.
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Suppression of the fibrinolytic system is a well-known phenomenon in patients with Behçet's disease. It is generally explained by an increase in the inhibitory potential. In order to prove this theory, the fibrinolytic system was investigated in 5 male patients with severe chronic Behçet's disease. By the venous occlusion test, a marked suppression of the activatability of the system could be demonstrated (euglobulin lysis time, various fibrin plate assays). Results of analysis of the known inhibitors could not explain the phenomenon: antithrombin III, alpha2-macroglobulin, fast-reacting alpha2-antiplasmin, C1 inactivator, and the plasmin-antiplasmin complex were normal. The only change was an elevation of alpha1-antitrypsin and fibrinogen in 4 patients possibly due to an acute phase reaction. In addition to the possibility of a hitherto unidentified inhibitor, therefore, a decrease in production or in release of vessel wall activators must also be considered in the pathogenesis of this disorder.
Intra-aortic balloon counterpulsation (IABP) was used in 20 patients with acute myocardial infarction and cardiogenic shock, after four hours of drug treatment. In all instances the abnormal haemodynamic state had been demonstrated. Four patients were successfully treated and finally discharged home. In two with post-infarction ventricular septal defect and cardiogenic shock, IABP also successfully reversed the shock state, while in seven the shock state was reversed but they died 2-8 days after IABP had been stopped. IABP failed in seven patients who died during its application. In those in whom IABP failed there had been no significant fall in pulmonary-artery pressure and no significant increase in stroke volume. The post-mortem examinations demonstrated that cardiogenic shock was irreversible where more than 50% of the left ventricular myocardium had been infarcted.
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